Summary & Overview
HCPCS S0622: Physical Exam for College, New or Established Patient
HCPCS Level II code S0622 represents a physical examination performed for college admission or enrollment, billed separately in addition to the applicable evaluation and management service. Nationally, this code standardizes reporting for routine student health clearance exams and helps payers and providers distinguish administrative or documentation-focused exams from problem-oriented office visits. The code is relevant for primary care, family medicine, pediatrics, and student health clinics across outpatient ambulatory settings.
Key payers considered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of how S0622 is used in practice, the clinical context for college physicals, and what to expect for claim reporting when a physical exam is performed in conjunction with an E/M visit. The publication summarizes common modifiers and operational considerations where available and notes when input data is not provided.
This brief equips revenue cycle, compliance, and clinical staff with the foundational information needed to identify when S0622 applies, aligns expectations across common national payers, and frames further exploration of reimbursement rules, payer-specific policies, and documentation expectations.
Billing Code Overview
HCPCS Level II code S0622 describes a physical examination for college entry, applicable to either new or established patients. The service is billed in addition to an appropriate evaluation and management code and is intended to document a focused physical exam required for college admission or enrollment processes.
Service Type: School/college physical examination
Typical Site of Service: Outpatient clinic or ambulatory setting, including primary care offices and student health centers
Clinical & Coding Specifications
Clinical Context
A college-bound 18-year-old patient presents to a primary care clinic for a required preparticipation physical examination and clearance form for college health services. The visit includes a focused physical exam to complete the institution's paperwork in addition to an otherwise appropriate Evaluation and Management visit for a new student establishing care. The clinician documents history, review of systems, focused examination findings (vital signs, HEENT, cardiovascular, pulmonary, musculoskeletal), immunization review, and any counseling required by the college. The physical exam element is reported separately using S0622 in addition to the E/M code for the visit when the exam is distinct from and beyond what is typically included in the E/M service. Typical workflow: scheduling staff verify need for college physical; patient completes required forms; clinician reviews forms and medical history; clinician performs focused physical exam; documentation includes exam components, forms completed, and any specific clearance statements; billing includes the primary E/M code for the encounter and an additional line item for S0622 when the exam is performed and billed separately.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service |